SURGERIES AND ORAL APPLIANCES FOR SLEEP APNEA - 2

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WHY DO SURGERIES FOR SLEEP APNEA FAIL IN SO MANY CASES?

-THROAT COLLAPSE IN SLEEP APNEA IS NOT A SIMPLE OBSTRUCTION BUT INSTEAD, A VACUUM COLLAPSE: MUCH LIKE "SUCKING ON A BALLOON".

--If you grasp a balloon at one point between your thumbs and fingers on two sides and pull it apart to try to keep it open at that point, and then suck on the balloon again, what happens? It sucks shut at another level. In fact, in some patients, the side walls of the throat were even found to suck inward and "slam together" in the midline--and one can't surgically remove the side walls of the throat!

--In contrast, positive airway pressure (PAP) tends to be much more reliably effective at eliminating throat collapse, since it is a more logical and direct approach to the basic problem. PAP can usually blow the entire upper airway open, irrespective of the level at which it had been collapsing.

-AIRWAY COLLAPSE MAY DEVELOP BELOW THE LEVEL WHERE THE SURGERY WAS PERFORMED.

--Imagine you have four dams on a river. Label one the nose, one the palate, one the base of the tongue, and the fourth, the part of the airway between the tongue and the vocal cords. Say that you want water to flow again. If you blow up only one or two of the four dams, what have you gained? Water still will not flow.

--Many people suck the base of their tongue down into the airway like a cork being sucked into a vacuum bottle, even if their soft palate has been trimmed.

-IN SLEEP APNEA, ONE IS DEALING NOT JUST WITH STRUCTURE BUT WITH FUNCTION OF THE AIRWAY.

--Some patients with obstructive sleep apnea demonstrate reasonably normal appearing throats but appear unable to coordinate their throat muscles during sleep.

--Also, people with sleep apnea have been found to have abnormal floppiness of the throat muscles that normally should pull their throat open as they breathe during sleep.

 

-INTERMITTENT SWELLING OF THE AIRWAY--ESPECIALLY THE NASAL PASSAGES--CAN CONTRIBUTE TO SLEEP APNEA.

--Even if one makes a nose structurally normal by surgery, that nose still can swell shut, particularly if the person has allergies that he or she may not even recognize--particularly if the problem is present year-around rather than occurring just during certain times of the year.

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If patients snore so loudly that they can drive bed partners out of the room, they usually have
a medically significant breathing problem--even if pauses in breathing haven't been noticed.
However, even when laser surgeries are done for simple, benign snoring, one Scandinavian study
found that although 86% of patients were better after 3 months, only 46% were still better
after 21 months. The rest had relapsed.

For the above reasons, it is difficult to recommend surgeries for the primary treatment
of sleep apnea...particularly if the sleep apnea is at all severe.


PLEASE NOTE THAT THE SITUATION IS SOMEWHAT DIFFERENT IN CHILDREN.

Pediatric cases of sleep apnea have a greater chance of response to such surgeries as tonsillectomy and adenoidectomy than do adults.

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ADVANTAGES OF POSITIVE AIRWAY PRESSURE (CPAP AND BILEVEL PAP)
OVER SLEEP APNEA SURGERIES

1. CHEAPER.

2. MUCH HIGHER SUCCESS RATES: for logical reasons.

3. SAFER. No postoperative/ anesthetic risks or complications.

4. BENEFITS ARE IMMEDIATE. Patients aren't left at risk of complications pending healing such as can occur even if surgeries are fully effective--(which they frequently are not).

5. CPAP AND BILEVEL PAP UNITS CAN BE TRIED ON A RENTAL BASIS AND RETURNED IF THEY DON'T "WORK OUT". Patients cannot "return surgeries" when they find they aren't happy with the results!

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ORAL APPLIANCES: ANOTHER TREATMENT OPTION

Specially fit oral appliances represent another therapeutic approach to sleep apnea in patients who are not candidates for positive airway pressure. Most of these fit over the upper and lower teeth and pull the lower teeth forward to advance the jaw and expand the size of the airway. These devices can prove very helpful in selected cases.

However, they are best utilized in milder cases of sleep apnea since they tend to be less reliably effective than positive airway pressure, and they are far less likely to improve low blood oxygen levels during sleep to an adequate degree. Other disadvantages include TM joint pain which can cause patients to be unable to use them consistently, changes in dental occlusion and the fact that they typically must be purchased and adjusted, followed by overnight sleep studies to find out if they corrected the patient's sleep apnea to an adequate degree.

At the same time, they represent a valuable alternative in selected patients.

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IN NEARLY ALL CASES, SLEEP APNEA CAN BE MANAGED WITHOUT SURGERY.

If you have undergone sleep testing but were left without treatment, do not simply proceed
with soft palate surgeries, given their high failure and relapse rates. Instead, click here.